LMR Georgette’s PMHNP
Certification Exam Latest 2026
Questions And Correct
Answers(Verified Answers)
What should you do when a mother reports her child woke up screaming
in the middle of the night? - ANSWER ✔✔Ask her if it's happened
before to assess for sleep issue patterns
What do you do if a patient comes in with fungus on their toenail? -
ANSWER ✔✔Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? -
ANSWER ✔✔Check renal function
What do you do if a patient presents with fever while on Clozaril? -
ANSWER ✔✔Check ANC level to assess for agranulocytosis
,What can cause serotonin syndrome? - ANSWER
✔✔Antidepressants, St. John's Wort, Same-E, Kava Kava, and
Tryptophan
What labs are indicative of NMS? - ANSWER ✔✔Elevated WBC
(over 11,000) and elevated CPK
S/S of NMS - ANSWER ✔✔muscle rigidity, hyperthermia,
tachycardia, abnormal bp, sweating, altered mental status, cherry
colored urine
What should you do if a patient presents with cherry colored urine? -
ANSWER ✔✔Check for rhabdo with CPK
s/s of serotonin syndrome - ANSWER ✔✔hyperreflexia, muscle
spasms, myoclonus (involuntary muscle jerk), fever, tachycardia, HTN,
shits and shivers
What two medications to give with NMS? - ANSWER
✔✔bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - ANSWER ✔✔cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
,What is the onset and typical length of NMS? - ANSWER ✔✔Slow
onset (1-2 weeks after changing or starting therapy) and resolves within
9-14 days
What is the onset of SS? - ANSWER ✔✔Within 24 hours of
starting/changing medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? -
ANSWER ✔✔NMS has a slower onset while acute dystonia occurs
within hours
What happens with lithium and NSAIDs? - ANSWER ✔✔Increased
risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - ANSWER
✔✔Increased risk of lithium toxicity related to the increased urination
from the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers? -
ANSWER ✔✔Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? - ANSWER ✔✔Epstein's
anomaly
3
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
, What lab should you check for athletes on lithium? - ANSWER
✔✔Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - ANSWER ✔✔Do not give
the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - ANSWER
✔✔>3
S/S of lithium toxicity - ANSWER ✔✔vomiting, diarrhea, slurred
speech, hand tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - ANSWER ✔✔Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? -
ANSWER ✔✔Synthroid
What do you do if patient is prescribed both depakote and lamictal? -
ANSWER ✔✔Decreased lamictal dose by 50%
Depakote and pregnancy - ANSWER ✔✔Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain? - ANSWER ✔✔Pancreatitis
What lab should you check if patient has right upper quadrant pain and
dark brown urine? - ANSWER ✔✔LFTs
Certification Exam Latest 2026
Questions And Correct
Answers(Verified Answers)
What should you do when a mother reports her child woke up screaming
in the middle of the night? - ANSWER ✔✔Ask her if it's happened
before to assess for sleep issue patterns
What do you do if a patient comes in with fungus on their toenail? -
ANSWER ✔✔Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? -
ANSWER ✔✔Check renal function
What do you do if a patient presents with fever while on Clozaril? -
ANSWER ✔✔Check ANC level to assess for agranulocytosis
,What can cause serotonin syndrome? - ANSWER
✔✔Antidepressants, St. John's Wort, Same-E, Kava Kava, and
Tryptophan
What labs are indicative of NMS? - ANSWER ✔✔Elevated WBC
(over 11,000) and elevated CPK
S/S of NMS - ANSWER ✔✔muscle rigidity, hyperthermia,
tachycardia, abnormal bp, sweating, altered mental status, cherry
colored urine
What should you do if a patient presents with cherry colored urine? -
ANSWER ✔✔Check for rhabdo with CPK
s/s of serotonin syndrome - ANSWER ✔✔hyperreflexia, muscle
spasms, myoclonus (involuntary muscle jerk), fever, tachycardia, HTN,
shits and shivers
What two medications to give with NMS? - ANSWER
✔✔bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - ANSWER ✔✔cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
,What is the onset and typical length of NMS? - ANSWER ✔✔Slow
onset (1-2 weeks after changing or starting therapy) and resolves within
9-14 days
What is the onset of SS? - ANSWER ✔✔Within 24 hours of
starting/changing medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? -
ANSWER ✔✔NMS has a slower onset while acute dystonia occurs
within hours
What happens with lithium and NSAIDs? - ANSWER ✔✔Increased
risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - ANSWER
✔✔Increased risk of lithium toxicity related to the increased urination
from the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers? -
ANSWER ✔✔Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? - ANSWER ✔✔Epstein's
anomaly
3
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
, What lab should you check for athletes on lithium? - ANSWER
✔✔Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - ANSWER ✔✔Do not give
the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - ANSWER
✔✔>3
S/S of lithium toxicity - ANSWER ✔✔vomiting, diarrhea, slurred
speech, hand tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - ANSWER ✔✔Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? -
ANSWER ✔✔Synthroid
What do you do if patient is prescribed both depakote and lamictal? -
ANSWER ✔✔Decreased lamictal dose by 50%
Depakote and pregnancy - ANSWER ✔✔Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain? - ANSWER ✔✔Pancreatitis
What lab should you check if patient has right upper quadrant pain and
dark brown urine? - ANSWER ✔✔LFTs
